Morale

Morale is at an all-time low since I've started.  Excellent experienced nurses and great new nurses with lots of potential to grow & develop are leaving, for multiple reasons: staffing, patient load, attitudes, drama, pay, HR issues.  It's sad to see staffing get tighter and tighter with nurses leaving twice as fast as they are coming in.  It's a concerning trend that our "customers" are blind to: from our point of view, "if you only knew what we're dealing with back here", and from management's point of view "you are not allowed to discuss any staffing details with patients and families, including answering how many doctors are on duty".  My motivation to work is still the fact that I get to learn about the human body, how it can turn on you and save you in one day, and the science behind medical treatments; as well as the several projects I have going on at work - Disaster Preparedness, Pediatric Operational Committee, and relief Charge Nurse.  Yep, that's right, I haven't been here 6 months and they've asked me to take on PRN Charge Nurse shifts.  I'm scared out of my mind, even more so, given how many nurses are bailing out.  We'll see what happens a few months down the road... I sure hope this is the bottom before things start getting better & it doesn't get much worse.

Fx Pelvis

Giving report to a floor:

Me: "Hi, it's Allie in the ER, I need to give report"

Floor RN: "Okay, go ahead."

Me: "Mmmmkay, I'm sending you a XX y/o F, pelvic Fx.  She's on bedrest, c/o severe pain with any movement; we've put in a foley."

Floor RN: "What's the reason for the foley?"

Me: "Like I said, she broke her pelvis, & any slightest movement causes her severe pain, including getting up on a bedpan (even the fracture pan)."

Floor RN: "Oh, ok."

Me: "Otherwise, she's resting comfortably in bed after some pain meds, has some labs due at midnight & again in AM, otherwise nothing else to do tonight."

Floor RN: "Okay.  Is she ambulatory?"

Me: *facepalm*  "No ma'am, like I've said twice already, she broke her [fucking] pelvis [are you listening to a word of what I've said so far?!], so no I don't believe she's ambulatory at this time."


Cannot make this sh!t up sometimes.  The most painful report I've had to give to date.

A Great Big Hole

A previously familiar to me gentleman comes into the ER via BLS whose report includes "we just found him like this": the gentleman is curled up on his left side, with an obvious deformed knee injury, after having fallen at a nearby construction site.  V/S upon triage as follows: 93/67, 61, 18, 87% on room air... Hmmm... My oh my, humpty dumpty, where did you fall?  A quick exam reveals severely diminished lung sounds on the right side & tenderness to the lower anterior ribs on the same side.  "Umm, Charge! We gotta come back to trauma & I need a chest xray & tube like 10 minutes ago."  ER Doc comes in & examines the guy: "Sir what happened today?"  "I fell."  "Where did you fall?"  "Into a great big hole."

Perspective

I may have not eaten anything for 13 hours; but neither did anyone else.  I may have treated close to 20 patients in a 12 hour period with all 4 rooms full at all times; but so did everyone else.  Never once did I feel like I was working alone.  Never once was I asked to compromise patient care or put my license at risk by taking on assignments I can't handle.  I know that I'm valued at work, I'm respected by fellow nurses, physicians, & ancillary staff.  I know that at any time I can ask a question, ask for help, or ask for a break & not be laughed at or ridiculed.  I know my leadership & management has my back, I know I can talk to them & express concerns or frustrations without getting written up for calling out because "if I come in tonight I feel like I will make a mistake, I'm too overwhelmed".  No joke, had a manager tell me that he strongly suggests that I come in to work tonight or else, after I explained how horrendous staffing has been & how overwhelming it is to deal with 14 beds by yourself without a tech or triage half the time for 7 hours each night.  It's all about perspective.

Only took 14 weeks

So I finally felt like I had my sh!t together at work for 12 hours without losing my mind... only took 14 weeks (6 weeks on my own on nights)... 90 day eval behind me & I was told they'd gladly send me through a preceptor class or charge nurse class when I felt ready :)  Amazing how different things are down here.  Wish more hospitals would catch on to the fact that if you given nurses' autonomy & include them in patient care decisions patient flow would move a lot faster through the ER & patient satisfaction would increase.  Imagine this scenario: you come to the ER complaining of chest pain, you are quickly triaged or perhaps even directly brought into the back (direct bedding) where EVERY SINGLE ROOM (including Fast Track) has a cardiac monitor that links to a central monitoring station at each nurses' station.  Your nurse meets you in your private room because all the ER staff communicate via radios with secret-service style ear-pieces & mics, to help cut down on the ambient noise.  Your nurse completes your assessment, charting at the bedside because each room has a computer & puts in protocol orders for an EKG, labs, xray & an IV.  Everything is done in less than 15 minutes, with bloodwork results in less than 30-45 minutes, ready for the doctor to review by the time he enters your room to examine you.  A med room in each nurses' station with literally hundreds of medications, in multiple formulations (lo and behold they actually have PO Zofran available, in table & liquid form too!), most commonly ordered by the ER Docs; rarely do we require a medication from the main pharmacy. Computerized order entry, to reduce redundancy in documentation & increase effective communication between providers.  A refreshing ability to be able to walk up to any ER doctor, regardless of whether they are seeing the patient or not & get an order for pain medication, nausea medication, fluids, extra labs, imaging, etc.  without even a hint of arrogance.  Oh & did I mention a 4:1 ratio, 3:1 in trauma?  Amazing...